Nasopharyngeal Tube and Functional Treatment in Pierre Robin Sequence: A Tertiary Clinical Experience From 150 Cases

2021 ◽  
pp. 105566562110311
Author(s):  
Fabian Blanc ◽  
Inge Harrewijn ◽  
Claire Duflos ◽  
Frederica Maggiulli ◽  
Guillaume Captier
Keyword(s):  
Oral Feeding ◽  
Pierre Robin Sequence ◽  
Robin Sequence ◽  
Initial Care ◽  
Nasopharyngeal Airway ◽  
Airway Tube ◽  
Group 3 ◽  
Group 2 ◽  
Pierre Robin ◽  
Group 1

Objectives: To describe the initial care practices for children with Pierre Robin sequence (PRS) and analyze the factors predicting the severity of the obstruction breathing disorders. Design: A retrospective single-center study of 150 children with PRS. Setting: Single tertiary care center, Regional Competence Center for the diagnosis and treatment of PRS. Patients: A total of 150 children with PRS consecutively followed between 1986 and 2017. Group 1 comprises children without specific respiratory management; group 2, children requiring prone positioning to alleviate their respiratory distress symptoms; and group 3, children requiring nasopharyngeal airway tube (NT) or nonconservative surgical treatment. Main outcome measures: Evolution and results of the initial treatment of PRS. Results: Forty-two percent (n = 63) were attributed to group 1, 39% (n = 50) to group 2, and 19% (n = 29) to group 3. Preterm birth, birth weight, or associated congenital malformations were not significantly different between the groups. However, the age of exclusive oral feeding was significantly different: 1 day (quartiles: 0-3) for group 1; 11 days (quartiles: 1-28) for group 2; 39 days (quartiles: 19-111) for group 3 ( P < .0001). Considering the NT, its use relieves the upper airway obstruction, assessed by a respiratory polygraphy, in 14 children. Conclusions: Nasopharyngeal airway tube has become our major first-line treatment, avoiding more complex procedures in most of the cases. The achievement of exclusive oral feeding seems to be a good predictor of the severity of respiratory symptoms in PRS.

How Does Hypodontia Compare in Nonsyndromic Pierre Robin Sequence Versus Isolated Cleft Palate and Isolated Cleft Lip?

2021 ◽  
pp. 105566562110177
Author(s):  
Maria Dillon ◽  
Madhavi Seshu ◽  
Norah Flanigan ◽  
Susana Dominguez-Gonzalez
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Pierre Robin Sequence ◽  
Robin Sequence ◽  
Sequence Versus ◽  
Group 2 ◽  
Alder Hey ◽  
Isolated Cleft Palate ◽  
Pierre Robin ◽  
Group 1

Objective: To assess the prevalence and patterns of hypodontia in nonsyndromic Pierre Robin sequence (PRS) and compare it with hypodontia in nonsyndromic isolated cleft palates and isolated cleft lips. Design: Retrospective cohort study. Setting: Alder Hey Children’s Hospital, United Kingdom. Patients: Patients with nonsyndromic PRS (group 1), isolated cleft palate (group 2), and isolated cleft lip (group 3). Main Outcome Measures: Hypodontia in the permanent dentition assessed from orthopantomographs. Results: A total of 154 patients were included. Group 1 had the highest incidence of hypodontia with 47% having at least one tooth congenitally absent. Groups 2 and 3 had reduced rates of hypodontia with 27% and 19% of the groups missing teeth, respectively; 93% of cases of hypodontia in group 1 involved the absence of at least one second premolar. Of these patients, there was found to be bilateral agenesis of second premolars in 50% of cases. Conclusions: Patients with PRS and cleft palates are more likely to have hypodontia than those with isolated cleft palates or unilateral cleft lips. Patients with PRS have more severe hypodontia than those with isolated cleft palates or unilateral cleft lips. Bilateral agenesis of lower second premolars is a commonly seen pattern among patients with PRS. In this large UK study, a similar prevalence and pattern of hypodontia to other nonsyndromic PRS populations worldwide has been demonstrated.

Subperiosteal Release of the Floor of the Mouth in Pierre Robin Sequence: Experience with 12 Cases

1996 ◽  
Vol 33 (6) ◽  
pp. 468-472 ◽  
Author(s):  
Louise Caouette-Laberge ◽  
Caroline Plamondon ◽  
Yvan Larocque
Keyword(s):  
Upper Airway ◽  
Oral Intake ◽  
Pierre Robin Sequence ◽  
Feeding Difficulties ◽  
Floor Of The Mouth ◽  
Robin Sequence ◽  
Group 2 ◽  
Systemic Antibiotics ◽  
Pierre Robin ◽  
Group 1

Between 1983 and 1995, 12 children with Pierre Robin sequence were treated with a subperiosteal release of the floor of the mouth (SRFM) to correct severe upper-airway obstruction (group 1: n = 10) and prolonged feeding difficulties (group 2: n = 2). Eight children had isolated Pierre Robin sequence, while four had associated anomalies. The age at surgery was 2 to 13 weeks (mean, 5.2 wk) in group 1, and 8.5 months to 5 years in group 2. Postoperative endotracheal intubation was maintained for 1 to 14 days, and nasopharyngeal intubation for 3 to 13 days. One child with a tracheostomy prior to SRFM was decanulated 11 weeks postoperatively. Postoperative course was uneventful and control polysomnograms (group 1) showed a marked improvement of the obstructive phenomenons and O2 saturation levels. Children were discharged 2 to 6 weeks postoperatively (mean, 4 wk) except for the child with a tracheostomy (19 wk). The only complication was a wound infection treated with systemic antibiotics. Oral feedings were initiated shortly after extubation: six children were discharged with oral feedings only, one child required supplemental gavages for 6 weeks at home, and three children had persistent inadequate oral intake. We have found SRFM to be an effective surgical procedure for the management of infants with Pierre Robin sequence.

A Systematic Review of Mandibular Distraction Osteogenesis Versus Orthodontic Airway Plate for Airway Obstruction Treatment in Pierre Robin Sequence

2021 ◽  
pp. 105566562110118
Author(s):  
Darren B. Abbas ◽  
Christopher Lavin ◽  
Evan J. Fahy ◽  
HyeRan Choo ◽  
Mai Thy Truong ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Distraction Osteogenesis ◽  
Literature Search ◽  
Oral Feeding ◽  
Treatment Modalities ◽  
Pierre Robin Sequence ◽  
Mandibular Distraction ◽  
Robin Sequence ◽  
Mandibular Distraction Osteogenesis ◽  
Pierre Robin

Objective: Mandibular distraction osteogenesis (MDO) is frequently performed to address airway obstruction in patients with Pierre Robin sequence (PRS), though more recently the technique of orthodontic airway plating (OAP) has gained traction. We aimed to evaluate OAP compared to MDO for airway obstruction in PRS. Design: A systematic literature search across PubMed, Embase, and Google Scholar identified all studies published in English, which involved MDO or any form of OAP as treatments for PRS. All relevant articles were reviewed in detail and reported on, adhering to PRISMA guidelines. Main Outcome Measures: Airway (tracheostomy avoidance, decannulation rate), feeding (full oral feeding tolerance). Results: Literature search identified 970 articles, of which 42 MDO studies and 9 OAP studies met criteria for review. A total of 1159 individuals were treated with MDO, and 322 individuals were treated with OAP. Primary outcomes appear similar for MDO and OAP at face value; however, this must be interpreted with different pretreatment contexts in mind. Conclusions: Orthodontic airway plating may be considered for airway obstruction in PRS, as some airway-related and feeding-related outcomes appear similar with MDO, per existing evidence in the literature. However, since PRS severity differed between studies, OAP cannot be uniformly considered a replacement for MDO. Further research is required to more comprehensively assess these treatment modalities inclusive of metrics that allow for direct comparison.

Feeding-Facilitating Techniques for the Nursing Infant with Robin Sequence

2006 ◽  
Vol 43 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Edamil Nassar ◽  
Ilza Lazarinni Marques ◽  
Alceu Sergio Trindade ◽  
Heloísa Bettiol
Keyword(s):  
Sao Paulo ◽  
Oral Feeding ◽  
São Paulo ◽  
Respiratory Obstruction ◽  
A Value ◽  
Robin Sequence ◽  
Evaluation Group ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objective To determine the effectiveness of feeding-facilitating techniques in children with Robin sequence. Setting Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, São Paulo, Brazil. Patients Twenty-six children less than 2 months of age with Robin sequence, whose only cause of respiratory obstruction was glossoptosis. Thirteen infants were treated by being placed in the prone position (Group 1), and 13 were treated by nasopharyngeal intubation (Group 2). Interventions During hospitalization, the following feeding-facilitating techniques were applied daily to all children: pacifier, massage to relax and anteriorize the tongue, long and soft bottle nipple with original or enlarged hole, global symmetric position, rhythmic movement of the nipple during suction, and insertion of the nipple on the tongue. Results During the first evaluation, Group 1 patients accepted 36.15 ± 33.05 mL milk orally within a period of 44.62 ± 42.94 minutes, whereas Group 2 ingested 20.00 ± 20.51 mL milk within 30.38 ± 25.77 minutes. A significant increase (p < .01) in the volume of ingested milk was observed for the two groups at hospital discharge after a mean treatment period of 10.7 days (Group 1: 63.46 ± 22.58 mL and Group 2: 55.00 ± 13.07 mL). The mean duration of feeding decreased in the two groups, with a value of 21.54 ± 7.18 minutes for Group 1 and of 20.28 ± 8.53 minutes for Group 2. Conclusion The results showed that feeding-facilitating techniques can foster oral feeding in infants with Robin sequence.

The successful use of the nasopharyngeal airway in Pierre Robin sequence: an 11-year experience

2012 ◽  
Vol 97 (4) ◽  
pp. 331-334 ◽  
Author(s):  
Francois Abel ◽  
Yogesh Bajaj ◽  
Michelle Wyatt ◽  
Colin Wallis
Keyword(s):  
Pierre Robin Sequence ◽  
Robin Sequence ◽  
Nasopharyngeal Airway ◽  
Pierre Robin

Management of Infants with Pierre Robin Sequence

2003 ◽  
Vol 40 (2) ◽  
pp. 180-185 ◽  
Author(s):  
Silke Wagener ◽  
Sukh S. Rayatt ◽  
Andy J. Tatman ◽  
Peter Gornall ◽  
Rona Slator
Keyword(s):  
Airway Obstruction ◽  
Outcome Measures ◽  
Nutritional Support ◽  
Upper Airway ◽  
Pierre Robin Sequence ◽  
Monitoring Methods ◽  
Feeding Difficulties ◽  
Robin Sequence ◽  
Nasopharyngeal Airway ◽  
Pierre Robin

Objective Several methods of treating babies with Pierre Robin sequence have been described since the condition itself was first documented in 1923. The main aim of treatment has been to relieve upper airway obstruction. Treatment methods used range from positioning of the baby to invasive surgery. The aim of this article was to describe the assessment, treatment, and monitoring methods used for babies referred with Pierre Robin sequence (PRS). Setting/Patients From December 1995 to May 2000, 22 consecutive patients were admitted to Birmingham Children's Hospital with PRS. Their airway and nutritional status were assessed and continuously monitored. Interventions Treatment concentrated on the relief of airway obstruction with a nasopharyngeal airway (NPA) and nutritional support of the babies until they grew out of their respiratory and feeding difficulties. Main Outcome Measures Outcome measures were oxygen saturation, growth of the babies, and the need for surgery. Results All babies were managed successfully with an NPA and nutritional support. No baby required surgery, and the majority showed good weight gain. Conclusion Relieving airway obstruction by NPA is an effective and safe treatment for babies with PRS until they have grown out of their respiratory and feeding difficulties. It avoids the need for surgery and can be used on neonatal wards using the monitoring described.

scholarly journals Bilateral Mandibular Distraction Osteogenesis in the Neonate with Pierre Robin Sequence and Airway Obstruction: A Primary Option

2012 ◽  
Vol 5 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Horácio Zenha ◽  
Luis Azevedo ◽  
Leonor Rios ◽  
Alberto Pereira ◽  
Armindo Pinto ◽  
...  
Keyword(s):  
Distraction Osteogenesis ◽  
Surgical Techniques ◽  
Oral Feeding ◽  
Long Term Results ◽  
Etiologic Factor ◽  
Pierre Robin Sequence ◽  
Mandibular Distraction ◽  
Robin Sequence ◽  
Mandibular Distraction Osteogenesis ◽  
Pierre Robin

Children with craniofacial abnormalities associated with retromicrognathia and glossoptosis often have compromised upper airway flow. In severe cases, emergency intubation is necessary immediately after birth, and tracheostomy is advocated to manage the airway in the neonatal period and to allow for feeding. Early intervention with bilateral mandibular osteogenesis avoids the need for tracheostomy, along with its complications, and it targets the primary etiologic factor of the problem—the anomalous anatomy of the mandible. We report two neonates with severe Pierre Robin sequence managed with bilateral mandibular distraction osteogenesis on day 9 and day 11 of life. The surgical techniques and distraction and consolidation periods were similar apart from the distraction devices used. The procedures were successful with early extubation (day 5 and day 7), oral feeding tolerance (day 11 and day 13) and hospital discharge (day 19 and day 18). Total mandibular distraction was 19 mm and 23.45 mm, respectively. No major complications were reported. Medium to long-term results were good. Bilateral mandibular distraction osteogenesis in the neonate is a safe and accurate procedure and is the primary option in cases of selected severe Pierre Robin sequence.

Sign in / Sign up

Export Citation Format

Share Document